Texas State Requirements for Assisted Living Facilities

Texas assisted living facility requirements are set by the Texas Health and Human Services Commission (HHSC), which licenses every facility, sorts them into two categories based on how independently residents can respond to an emergency, and layers additional rules on top for memory care, staffing, medications, safety, and resident rights. No facility can operate without an HHSC license, and none can exceed the resident count on that license.¹

License Types: Type A, Type B, and Alzheimer’s Certification

The license a facility holds determines which residents it can accept.

A Type A facility serves residents who can evacuate the building without staff help, follow directions in an emergency, and do not need routine supervision while sleeping. A Type B facility serves residents who may need staff assistance to evacuate, may not be able to follow emergency directions, or may need staff present overnight. Type B residents can also need help transferring in and out of bed, but they cannot be permanently bedfast.²

Any facility that advertises or promotes itself as providing specialized care for Alzheimer’s disease or other dementias must hold a separate Alzheimer’s Disease and Dementia Care Certification, and it must already carry a Type B license.² A Type A facility cannot simply add a “memory care wing” without upgrading its license and obtaining the certification. The certification also triggers heavier staffing, training, and disclosure requirements described further below.

Staffing, Training, and Background Checks

Every facility must designate a manager responsible for daily operations. The manager must complete at least 24 hours of training covering resident assessment, management principles, and state licensing standards. Eight of those hours, focused specifically on assisted living licensing standards, must be completed within the first three months on the job, and managers must complete continuing education each year.

Managers of Alzheimer’s-certified facilities, and supervisors of certified dementia care units, face additional qualifications. They must be at least 21 years old and meet one of three education thresholds: an associate’s degree in nursing or health care management; a bachelor’s degree in psychology, gerontology, nursing, or a related field; or a high school diploma with at least one year of experience working directly with people who have dementia. They must also complete six hours of continuing education about dementia care each year.³

Every prospective employee must clear a criminal history check before the facility offers them a position that involves direct contact with residents. In an emergency staffing situation, a facility may hire someone before results come back, but it must submit the applicant’s information to the appropriate regulatory agency within 72 hours.⁴

Direct care staff receive orientation on hire and must complete ongoing annual education covering emergency procedures, managing challenging behaviors, and the Resident’s Bill of Rights. At Alzheimer’s-certified facilities, the requirements climb sharply. Before working directly with residents, staff must complete four hours of dementia-specific orientation covering the nature of Alzheimer’s, managing difficult behaviors, and identifying safety risks. Within their first 16 hours of employment they must finish another 16 hours of on-the-job training. After that, dementia care staff must complete 12 hours of in-service education about Alzheimer’s disease each year, with at least one hour dedicated to behavior management, fall prevention, or alternatives to restraints.⁵

Resident Assessments and Service Plans

Within 14 days of admission, the facility must complete a comprehensive assessment of each resident’s needs, preferences, strengths, and functional abilities. The assessment covers physical and mental health, nutritional requirements, and the resident’s ability to handle daily activities like bathing, dressing, and eating.⁶

Staff use that assessment to build an individualized service plan, with input from the resident’s family when available. The plan must address the resident’s specific needs, preferences, and strengths, and it has to be completed within the same 14-day window. Both documents are updated at least annually and whenever the resident’s condition changes significantly, such as a major decline or improvement that calls for a new approach to care.⁶

Medication Rules

Texas draws a sharp line between helping a resident take medication and actually administering it. Confusing the two is one of the fastest ways for a facility to land in regulatory trouble.

Medication assistance, sometimes called medication supervision, means staff help a resident who is still managing their own medication but needs a hand. This includes picking up prescriptions from the pharmacy, reminding the resident it is time for a dose, pouring the prescribed amount, handing the poured medication to the resident, and returning the medication to locked storage. Staff must watch the resident take the medication and document any missed doses.⁷

Medication administration is a different category. If staff place medication in a resident’s mouth or apply it to a resident’s body, that counts as administration, and only three categories of people may do it:

A licensed nurse employed by or contracted with the facility
A permitted medication aide acting under the authority of a nurse who is on duty or on call
A facility attendant to whom a registered nurse has specifically delegated the task, consistent with the Texas Board of Nursing delegation rules

Medication administration must always follow physician orders.⁷

Facilities must also provide three nutritious meals daily and accommodate residents’ dietary needs and preferences.

Incident Reporting

When something serious happens, facilities cannot handle it quietly. Texas requires providers to report certain incidents to HHSC’s Complaint and Incident Intake office, including abuse, neglect, exploitation, and suspicious injuries of unknown source. The initial report must be made immediately and no later than 24 hours after the incident occurs or is suspected, followed by a completed incident form within five calendar days.⁸

An injury qualifies as suspicious and of unknown source when no one observed how it happened, the resident cannot explain it, and the injury raises concern because of its severity, location on the body, or a pattern of repeated injuries over time. Routine injuries clearly unrelated to abuse or neglect do not have to be reported to the state, though the facility must still document them internally.⁸

Building Safety and Room Standards

Fire Protection

Fire safety requirements scale with a facility’s size and license type, but all facilities must have functioning fire alarm and smoke detection systems meeting National Fire Protection Association (NFPA) standards. For new large Type B facilities, the fire alarm system must meet NFPA 101, Chapter 18 (New Health Care Occupancies), any alarm device must automatically trigger the building-wide evacuation alarm, and a fire sprinkler system meeting NFPA 13 is mandatory.⁹ Smaller and Type A facilities face requirements calibrated to their lower-risk profile, though fire detection and alarm systems are universally required.

Every facility must run regular fire drills and maintain a written emergency preparedness plan for fires, severe weather, and other disasters. Deferred maintenance on sprinklers or alarms is a common citation during HHSC surveys.

Room Size

HHSC sets minimum floor space standards for resident bedrooms. In existing small Type A facilities, a single-occupancy bedroom must have at least 80 usable square feet, and rooms housing multiple residents must provide at least 60 square feet per person. Any portion of a bedroom narrower than eight feet in its smallest dimension does not count toward the square footage requirement unless HHSC grants an exception.¹⁰ Bathrooms must include accessibility features for residents with mobility challenges.

Resident Agreements and Required Disclosures

Before a resident moves in, the facility must provide a disclosure statement describing its services, staffing policies, and philosophy of care. A written contract has to spell out every service the facility will provide, the rates for each, and any additional charges the resident might incur. Vague pricing language is worth pushing back on before signing.

Facilities holding Alzheimer’s certification must also provide a separate Alzheimer’s Disclosure Statement (HHSC Form 3641) to anyone seeking information about the facility’s dementia care. Staff must sit down with the family or responsible party and walk through the disclosure before admission. It covers preadmission procedures, how the facility handles changes in condition, staffing levels, staff training in dementia care, and the physical environment of the memory care area.² The disclosure must be updated whenever the facility changes its dementia-related services, and the updated version submitted to HHSC.

Resident Rights

Texas protects assisted living residents through a Resident’s Bill of Rights set out in the state’s administrative code. Facilities must give each resident a copy and post the rights prominently in a common area, written in the primary language of each resident.¹¹ Key protections include:

Being treated with dignity and respect regardless of race, religion, sex, age, disability, or source of payment
Making personal decisions about affairs, care, and services
Privacy in medical treatment, written communications, phone calls, meetings with family, and a private place to receive visitors
Managing their own financial affairs
Filing complaints about care or treatment, anonymously if they choose, with a prompt facility response and no retaliation

These rights apply to every resident in every licensed facility, and a facility’s failure to honor them is a regulatory violation that families should report.¹¹

How to Report a Problem

When problems come up, residents and families can start inside the facility: talk with staff, request a written grievance form, or bring concerns to a resident or family council. When that does not resolve things, two state resources exist.

The Texas Long-Term Care Ombudsman Program advocates for residents of assisted living facilities and nursing homes. Ombudsman representatives investigate complaints, work with the facility on solutions, and help residents access legal or administrative remedies when their rights are being violated. The program is authorized under federal law and operates in every state.¹² The State Long-Term Care Ombudsman can be reached at 800-252-2412 or ltc.ombudsman@hhs.texas.gov.¹³

For serious concerns involving abuse, neglect, exploitation, or immediate safety hazards, contact HHSC’s Complaint and Incident Intake line at 800-458-9858 or ciicomplaints@hhsc.state.tx.us. This is the same office that receives mandatory incident reports from facilities, so a family complaint may trigger or supplement an existing investigation.¹³

1
Cornell Law Institute. Texas Administrative Code 26-553.17 – Criteria for Licensing
2
ASPE, HHS. Residential Care/Assisted Living Compendium: Texas
3
Legal Information Institute. Texas Administrative Code 26-553.301 – Manager Qualifications and Training
4
Texas Health and Human Services. Appendix VIII, Criminal History Check of Employees
5
Texas Health and Human Services. Alzheimer’s Certification Checklist
6
Legal Information Institute. Texas Administrative Code 26-553.307 – Admission Procedures, Assessment, and Service Plan
7
Texas Health and Human Services. PL 2023-22 Medication Services for Residents in an ALF
8
Texas Health and Human Services. Types of Incidents Providers Must Report to HHSC
9
Cornell Law School. Texas Administrative Code 26-553.245 – Fire Protection Systems Requirements for a New Large Type B Assisted Living Facility
10
Legal Information Institute. Texas Administrative Code 26-553.112
11
Legal Information Institute. Texas Administrative Code 26-553.267 – Rights
12
eCFR. 45 CFR Part 1324 Subpart A – State Long-Term Care Ombudsman Program
13
State Long-Term Care Ombudsman – Texas.gov. For Residents